Multiple pregnancy after IVF. Twins after IVF: all the pros and cons of “double success.

Causes and probability of having twins during IVF To increase the effectiveness of the IVF procedure (in vitro fertilization), and sometimes just to induce ovulation in anovulatory forms of infertility, one has to resort to hormonal stimulation, which results in not one, but several eggs.

After in vitro fertilization, several embryos are obtained. If two embryos are transferred into the uterus, fraternal twins can be obtained.

The likelihood that twins will be born after IVF is quite high, and this is one of the reasons for dissatisfaction with the results of the procedure.

Bearing, birth and the first stages of life of such children, as a rule, have difficulties.

Some statistics. When transferring two embryos (in developed countries, this number is determined by law, as in many clinics in Russia that respect their reputation), the pregnancy rate is 40-45%, when transferring one embryo, 35-38%. At the same time, the chance that twins will be born after IVF in the first case is 32%. In the second case, the risk that twins will be conceived as a result of IVF is only 0.8%.

These data are confirmed by many authors. Thus, a slight decrease in the percentage of pregnancy during the transfer of one embryo is compensated by obtaining a singleton physiological pregnancy. And this is precisely the main task of ART.

If everything is clear enough fraternal twins, then not everything is so simple with monozygotic twins or, even more rarely, triplets after IVF. This is indeed a rare situation. And, nevertheless, the statistics of the birth of such children shows an increase from 0.42% (in the general population) to 1.2-8.9% (according to different authors) after the use of ART.

Many authors show the relationship between the increase in the birth of monozygotic twins (MZB) with the conditions of cultivation and various manipulations with embryos. Indeed, the first days, even hours of development, are very vulnerable, and the presence of embryos in sufficiently stressful conditions cannot but affect their future fate. Therefore, most authors suggest a relationship between the duration of cultivation and the appearance of MZB.

Transfer to the third day compared with extended cultivation (fifth day) gave a higher percentage of MZB birth. The authors found 4 cases of MZB (1.57%) during blastocyst transfer. At the same time, the results indicated that the percentage of pregnancy on day 5 was 67.8 compared to 36% of the transfer on day 3, and it was noted that, given these results, such an increase in the percentage of MZB can be neglected.

Some authors have shown a higher risk of MZD if the transferred blastocysts were obtained after ICSI, assisted hatching, or PGD (preimplantation genetic diagnosis).

All these procedures lead to the formation of a hole in the shell of the embryo, which can affect the integrity of the ECM, but why, then, in all patients after ICSI, hatching and PGD, MZB is not born, but at the same time they can occur in classical IVF options that do not involve manipulations with shells of the embryo. Moreover, an increase in MZB is also noted during the procedure of artificial insemination, which generally does not involve the stage of in vitro cultivation of embryos.

Other authors argue that ovarian stimulation itself can lead to an increase in the birth of MZB. The effect of increasing the MZB was found with the abolition of oral contraceptives and pregnancy in the first 3 months. Some studies note the effect of clomiphene citrate on the level of MZB. Back in 1987, work was carried out indicating that artificial induction of ovulation may be the first biological mechanism influencing the appearance of MZD.

Thus, almost all authors agree that the etiology of the appearance of MZD is more associated with the use of gonadotropins in ART practice than with laboratory culture conditions and micromanipulations with embryos.

In conclusion, it must be said that many years of experience in having children after ART methods have not finally clarified the reasons for the appearance of monozygotic twins. The birth of a child is a miracle, and the appearance of twins, even more similar friend on the other like two drops of water, a miracle doubly, because "miracle" we call everything that we can not pick up a clear explanation.

Our specialists

About how to behave during multiple pregnancy and childbirth, the correspondent of the magazine " Women Health”(6/2000) tells the obstetrician-gynecologist of the Kirov maternity hospital 24 Inna Lvovna KOSYGINA.

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Inna Lvovna KOSYGINA, an obstetrician-gynecologist of the Kirov Maternity Hospital 24, tells the correspondent of the Women's Health magazine about how to behave during multiple pregnancy and childbirth:

- Twins or as many as three babies ... How often does such a miracle happen and what affects the fact that not one, but two or more embryos develop in the mother's womb?

- Today, the birth of twins occurs once in forty, while earlier - in fifty births, and according to statistics maintained in the West, it is believed that two out of a hundred families expect "double" happiness. In the early 80s, only one pregnant woman out of a hundred could count on such joy. This is explained by the following reasons: firstly, today more and more women are postponing the birth of children to a later date. And with age, the concentration of a hormone such as FSH in their blood increases, which stimulates the maturation of the egg. Thus, several eggs ready for fertilization can immediately mature at the same time. Secondly, if a woman cannot get pregnant naturally, she turns to reproductive centers, where she undergoes a course of hormonal therapy, which also often results in the maturation of several eggs.

There is another very interesting point: twins can be born in two ways: either a fertilized egg is divided at a very early stage, or two eggs are fertilized at once. In the first case, twins are called identical, and the probability of their birth is approximately 25 out of 100 twins, while the remaining 75 are fraternal twins and sometimes resemble each other no more than ordinary brother and sister.

- When can a woman find out that she will have more than one child?

- Not so long ago - about 25 years ago - that not one, but several babies would be born, could only be known in childbirth or not earlier than the 20th week of pregnancy. Today's expectant mothers can find out how many kids to expect already at the 7-10th week of pregnancy: listening to the heart tone and ultrasound can do this.

- Is the management of pregnancy of a woman who carries several babies under her heart different from monitoring a pregnant woman with a "usual" number of babies?

- Undoubtedly. As soon as the doctor of the antenatal clinic determines that the expectant mother is expecting twins, or even triplets, he enrolls her in the category of pregnant women with a high degree of risk. Unlike the woman who is pregnant with one child, a pregnant woman with twins will have to undergo more preventive examinations: after 20 weeks - once every two weeks and every week - after 30 weeks.

- What is the difference between pregnancy with several children?

- Women who are pregnant with more than one child have a higher risk of toxicosis, both in the early stages and after the 20th week. The level of hormones in the blood is much higher than during normal pregnancy, and therefore, multiple mothers are more prone to morning sickness. In addition, the likelihood of varicose veins due to weight gain is high, and the load on the heart muscle increases three to four times. Much more often than in singleton pregnancies, expectant mothers of several children suffer from iron deficiency.

- Of course. First, they need to remember about additional nutrition. The fact is that in the case of expecting twins, the volume of the stomach of the expectant mother decreases due to squeezing it by the stretched uterus. For this reason, meals should be divided into six small portions, which will include foods that are valuable for the body of a pregnant woman.

In addition, the usual dose of the right substances is multiplied if you are expecting twins, by two, by three, if you are expecting triplets, and so on. For example, to “fulfill” the daily calcium requirement, which during a normal pregnancy is 1,280-1,300 mg per day, which is approximately 200 ml of skim milk or 110 g of salmon with bones from a can, you need to multiply 200 ml of milk or 110 g of fish by two . It turns out that a mother expecting twins needs to eat either 220 g of salmon or drink 400 ml of milk during the day.

And a few more tips related directly to nutrition.

Since a pregnant woman is deficient in iron, she should not only take preparations containing iron prescribed by a doctor, but also replenish her body with iron in a natural way. Here are foods that contain it in large quantities: cereals, beef, liver and other offal, sardines, turnips, artichokes, melons, jacket-baked potatoes, spinach, soybeans, molasses, dried vegetables. And for the reason that the vessels are overloaded, vitamin C should also be consumed daily.

To get the right amount of vitamin C per day, you need to eat at least two of the following foods: 1 grapefruit, 1 glass of grapefruit juice, three medium oranges, one mango, two large tomatoes, 100 g vegetable juice, one bell pepper, half a cup of boiled colored cabbage.

And most likely the doctor will prescribe you folic acid in tablets or in vitamin complexes, since it is necessary for normal tissue growth.

It should also be taken into account that the expectant mother of twins needs additional rest: involve your husband and other household members in housework, instead of standing at the stove for hours, buy frozen vegetables, high-quality semi-finished products.

At the first opportunity (at least 2-3 hours a day), take a reclining position and put your feet on a raised platform to relieve tension and pressure from the cervix. It may make sense to go on maternity leave earlier than during a normal pregnancy, or even leave work for a while.

Excessive mobility and physical activity are harmful, and perhaps the only safe sport in given state- this is swimming, and then only after consulting a doctor. For the same reason, be careful with prenatal classes, avoid those that are very active in prenatal exercises.

- Is it true that multiple pregnancy, as a rule, ends with premature birth, and is it possible to insure against this?

- Indeed, a double or even triple load on the uterus often leads to the fact that the uterine os begins to open ahead of time and contractions begin.

It is for this reason that most of the twins are born prematurely - somewhere after the 37th week, and only 10% of the twins "stand" until the prescribed 40 weeks. And the main task of the doctor who leads such a pregnant woman is to “keep” the babies in the mother’s womb for as long as possible.

So, for example, if there is a threat of premature opening of the uterine os, a suture is applied to it or a special soft silicone ring is put on the cervix. They are removed shortly before childbirth. If necessary, a woman is sent to a hospital under constant supervision, and they try to stop premature contractions with medication.

Is the birth of twins or more possible only by caesarean section?

- Not at all, every second twin is born today without surgery. As a rule, an operation is planned if there is a breech and transverse presentation of the fetus, or if the uterus is already weak and can no longer “hold” the children. In the latter case, preferably C-section if the weight of children does not exceed 1800 g, as they are very weak and may not withstand natural childbirth. The operation is also planned in case of any diseases of the mother: heart, kidneys, and so on. As for surgical intervention directly in childbirth, it is resorted to with unexpected complications, for example, when one fetus prevents the exit of another.

“They say that the stronger twin is the first to be born, is that true?”

- These are myths. One of the main roles in who will be born faster is the location of the fetus. Although the second child may indeed have a harder time because, for example, after the first child has left the uterus, it becomes more spacious and the second baby may take a position that prevents natural childbirth. As for the strong and the weak... Each twin initially "does not reach" the weight of a single newborn on average 1000 g, and the difference in weight between babies from one womb can range from 100 to 500 g.

The situation when a woman becomes pregnant with not one, but at the same time several future little men is not such a rare occurrence and occurs in approximately 0.7 - 1.5% of cases of the total number of pregnancies. It should be noted that twin pregnancy accounts for 99% of the total number of multiple pregnancies and 1% is a triplet pregnancy. Although the quadruple, five are not excluded.

Doctors believe that the maximum number of fetuses that women can bear without endangering their own health and the health of children is 6. An interesting fact is that a greater number of multiple pregnancies are observed on the African continent, while in China and Japan, twins / triplets are rare.

Pregnancy with twins, triplets...

A multiple pregnancy is called one when several fetuses develop and grow simultaneously in a woman's fetus. Multiple pregnancy is classified according to several factors. Depending on the number of fetuses, pregnancy is distinguished by twins, triplets, quadruples, and so on. The number of fertilized eggs also matters, that is, multiple pregnancy is possible, single and double.

Fraternal twins occurs more often and its frequency is 70%. The mechanism of the occurrence of fraternal twins is that 2 eggs mature in the ovary or ovaries at the same time, which can meet with spermatozoa both during one sexual intercourse and as a result of two intercourses, provided that the period between them is no more than 7 days.

Fertilization of two eggs is possible by spermatozoa of both one partner and (not so uncommon) by two men. A good example of such fertilization is the film "Cuckoo". If identical twins have exactly the same set of genes and are like two drops of water, then the similarity of fraternal children is only general, as between brothers and sisters who were born at different times.

identical twins always of the same sex, while heterozygous children are of different sexes. With a fraternal multiple pregnancy, each fetus has its own personal placenta and amnion, so such a pregnancy is called bichorial biamniotic. In the case of an identical pregnancy, the egg is divided into several after fertilization. Depending on the time period when the egg is divided, the following are distinguished:

• bichorionic biamniotic identical twins (separation occurred at the stage of advancement of the fertilized egg through the tube to the uterus - the first 3 days);
• monochorionic biamniotic identical twins (the division took place within 3-8 days after conception, while 2 embryos are formed, each in its own amnion, but with a common chorion / placenta);
• monochorionic monoamniotic twins (dividing of the egg in the period of 8-13 days after fertilization, while the embryos have a common chorion and are in a common fetal bladder);
• Siamese or fused twins, when the division occurred later than 13 days (such twins can grow together with the tailbones, lumbar spine, chest or skull bones).

The prognosis of pregnancy / childbirth is most unfavorable in the case of monochorionic monoamniotic twins.

Why does multiple pregnancy occur?

There are many factors that predispose to the conception of twins:

Heredity

This factor is considered the most indisputable. If the spouses had twins in a relationship, then the probability of pregnancy with several fetuses increases several times. Moreover, it is noticed that pregnancy with twins is transmitted through the generation.

Woman's age

It is noted that the older a woman is, the higher her chances of becoming pregnant with twins or triplets. This age limit is the 35th anniversary, that is, on the eve of premenopause and the onset of menopause, not all menstrual cycles occur with ovulation. In turn, anovulatory cycles alternate with ovulatory ones, when a surge of hormones occurs, a powerful stimulation of ovulation occurs, as a result of which 2 or more eggs mature at the same time.

Stimulation of ovulation

When prescribing infertility treatment, as a rule, use hormonal preparations stimulating the maturation of follicles (clomiphene or gonadotropin). Under the influence of these drugs, several follicles can mature at the same time.

Hormonal contraception

Often, multiple pregnancy is due to the use of combined oral contraceptives. After discontinuation of the drug, the "sleeping" ovaries are activated and begin to rapidly synthesize their own hormones, which leads to the maturation of several eggs. This situation is called the rebound effect.

in vitro fertilization

The development of reproductive technologies, in particular IVF, is one of the causes of multiple pregnancy. The bottom line is that after “in vitro conception”, several grown eggs are grown, which, in an amount of up to 4 pieces, are planted with the mother. If in the 80s the percentage of multiple pregnancies after the use of assisted reproductive technologies reached 30, then today it is 50%.

Parity

Most often, multiple pregnancies occur in multi-pregnant women. Moreover, it was noted that the greater the number of births in history, the higher the chances of a woman becoming a mother of twins or triplets.

What is the difference between a multiple pregnancy and a single pregnancy?

twin pregnancy signs

Signs appear from the very first days, and on their basis a woman may suspect that not only one baby, but two, is developing in her womb. So, the initial signs of pregnancy, such as:

• increased sense of smell, intolerance to certain odors
• the appearance of more pronounced engorgement of the mammary glands
• the early appearance of age spots on the face alarms the woman, and she is in a hurry to take a pregnancy test.

And here a certain surprise awaits her - the test strip is very pronounced and oily. The described symptoms are explained by a doubling of hCG, which increases the intensity of the initial signs and the brightness of the test strip.

• Toxicosis

In addition, during twin pregnancy, early toxicosis begins much earlier than during normal pregnancy, lasts harder and longer, up to 16-17 weeks. And there is a reason for this fact. The main culprit of toxicosis is the fetus, and if there are several of them, respectively, the signs of toxicosis will be more intense. If during the bearing of one fetus, a woman can only be disturbed by heartburn and nausea, then during pregnancy with twins, discomfort is expressed in vomiting, increased salivation, excessive fatigue and drowsiness. A rare future mother manages to avoid manifestations of early toxicosis, which also distinguishes twin pregnancy from pregnancy with one fetus.

Belly during pregnancy with twins

The abdomen begins to increase earlier, so by 12 weeks the uterus in a singleton pregnancy only slightly protrudes above the womb, and if there are several fetuses, it can almost reach the navel. Accordingly, the woman begins to feel the movement of the fetus earlier, firstly, because of the tightness of the babies, and secondly, because of the overstretching and thinning of the walls of the uterus.

twin pregnancy weight

Weight in multiple pregnancies also deserves special attention. Weight gain in a woman pregnant with twins is more significant and increases rapidly from the first weeks.

Diagnosis of fetal defects

Another feature of twin pregnancy is the result of the "triple test" - the diagnosis of congenital malformations of the baby's malformations. The analysis data are indicative, since alpha-fetoprotein, human chorionic gonadotropin and placental lactogen are synthesized in greater quantities than during pregnancy by one fetus, so the results may be false positive.

Edema, shortness of breath

Preeclampsia

Gestosis during pregnancy with several fetuses is diagnosed in almost half of the cases, and they develop earlier and are more severe. On the one hand, this is due to an increase in BCC and an increase in glomerular filtration in the kidneys, which causes an increase in blood pressure, edema and proteinuria, on the other hand, the occurrence of preeclampsia is provoked by chronic diseases of the mother, which, as mentioned, are exacerbated in 100% of cases.

Anemia

In addition, due to blood dilution (an increase in plasma volume), hemoglobin and red blood cells decrease - a common phenomenon and is called physiological anemia during pregnancy. However, as the duration of pregnancy increases, erythropoiesis increases in intensity, which leads to the depletion of the iron depot in the woman's body and triggers the mechanism of iron deficiency anemia.

constipation

An overdistended uterus compresses the intestines, so during pregnancy with twins, women often suffer from constipation, and put pressure on the urinary tract, which causes the frequent development of gestational pyelonephritis.

Management of twin pregnancy

Women carrying twins are at high risk and require careful monitoring throughout the entire period of expectation of children. So, visits to the antenatal clinic for such pregnant women are prescribed more often than during normal pregnancy, every 14 days up to 28 weeks, and then every 7 to 10 days. Besides, maternity leave issued at the wrong 30 weeks of pregnancy, but at 28 weeks, and sick leave a total of 160 days.

Particular attention should be paid to such pregnant women nutrition. If the weight gain during pregnancy with one fetus as a whole is 9-13 kg, then during pregnancy with twins it can reach 20 kg. Accordingly, the daily calorie content of the diet also increases (up to 4000 - 4500 kcal).

Given the increased demand for minerals and vitamins, therefore, it is recommended to start taking vitamin and mineral complexes from the moment the fact of multiple pregnancy is confirmed.

Folic acid, which is prescribed in the first 12 weeks of pregnancy (see) to prevent malformations of the brain and spinal cord, 0.4 mg / day, pregnant twins are prescribed 1 mg / day. Anemia is also prevented by prescribing iron-containing preparations from 15 to 20 weeks, 80 to 100 mg per day.

Complications

In addition to the listed features and complications of multiple pregnancy, twin pregnancy also has specific complications:

• the phenomenon of the death of one of the embryos or anembryony (this phenomenon occurs in 15 - 20% of cases, and the reasons are not exactly established, the fetal egg stops developing and either undergoes reduction - resorption or is in the uterus until childbirth);
• feto-fetal blood transfusion syndrome (SFTG) - the presence of anastomoses between the fetoplacental systems of both fetuses (occurs in monozygotic monochorionic twins), redistribution of blood occurs, and one fetus gets more of it, and the other less, and both fetuses suffer;
• fusion of children - Siamese twins;
• antenatal death of one baby;
• congenital "malformations" in one of the twins;
• a chromosomal disorder in one of the children;
• reverse arterial perfusion.

Case Study: I had a 30-year-old multi-pregnant woman on my account. She had a second, desired pregnancy, but, fortunately or unfortunately, twins. Interestingly, the patient's previous birth ended in a caesarean section, so she automatically fell into the high-risk group and underwent a planned operation. When registering, the woman assumed that she had a short period, in accordance with menstruation, 10-11 weeks. But at the very first gynecological examination, I suspected something was wrong and sent the patient for an ultrasound scan (the uterus was enlarged to 15-16 weeks). To our common joy, the twins were confirmed, and the subsequent pregnancy proceeded well. However, in the period of 22 weeks, the woman neglected the recommendations and dragged bags of potatoes, which ended very badly: a late miscarriage. But after a couple of years, the same patient becomes pregnant again and the situation repeats itself: twins. Again, my colleague and I almost blow dust off her, but at 22-23 weeks she wanted to travel (she went to her husband by train, who was on a long business trip), despising our advice and warnings. And, of course, the situation repeated itself (but in a different hospital). The result is disappointing: a burdened obstetric history, a scar on the uterus,.

Twins after IVF

Many childless couples resort to attempting IVF. The essence of in vitro fertilization is the removal of mature eggs from a woman, their fertilization "in vitro", as they say, in a test tube, and then the introduction of fertilized eggs into the uterine cavity. To date, the introduction of one to four eggs is allowed (depending on the quality and quantity of fertilized eggs obtained in vitro).

Therefore, the percentage of multiple pregnancies after IVF reaches 70 - 80. Multiple pregnancy is already a serious test for a woman, and after the use of assisted reproductive technologies, it is fraught with multiple complications due to severe disorders in the reproductive system and the presence of extragenital diseases and requires careful monitoring and control of the dynamics of analyzes .

• In the first trimester, it is important to regularly examine the hormonal level of a woman's body, especially the levels of hCG and estradiol.
• In the second / third trimesters, twin pregnancy that occurs after IVF is threatened by the occurrence of isthmic-cervical insufficiency, as well as interruption. Therefore, when pregnant with more than two fetuses, a woman is reduced to "extra" embryos.

Reduction (removal) is optimally performed at 9-11 weeks of gestation. There are 3 ways of reduction: transcervical, transvaginal and transabdominal. Transabdominal reduction is considered the safest, when, under the control of ultrasound monitoring, a needle inserted into the uterus, puncturing the anterior abdominal wall, pierces the embryo.

Example from practice: A young woman, 28 years old, after unsuccessful attempts to get pregnant and undergoing several courses of treatment, resorted to the IVF method. As a result, she had a long-awaited pregnancy with two fetuses. Up to 22 weeks, the pregnancy proceeded remarkably, without complications, characteristic not only for multiple, but also for singleton pregnancy. The woman strictly followed the medical recommendations, took the necessary drugs and regularly visited the antenatal clinic. But at a period of 22 weeks, the patient was admitted to the hospital with overflowing waters and severe external bleeding. It is clear that the pregnancy could not be saved.

Diagnosis of twin pregnancy

How to determine the pregnancy of twins?

• A doctor can suspect a multiple pregnancy already at the first gynecological examination. At the same time, a soft uterus is palpated, the size of which does not coincide with the delay in menstruation. But the initial examination, the collection of anamnesis and complaints can only make a presumptive diagnosis. It is possible that the large size of the uterus is associated with the presence of myomatous nodes.
• Reliably confirms the diagnosis only by ultrasound, during which the presence of two or more embryos is determined.
• Determining the level of hCG in short periods of pregnancy is an indirect confirmation of multiple pregnancy, so an increase in hCG levels is also possible with trophoblastic diseases ().
• Further ultrasound in due time (22-24 and 32-34 weeks) allows not only to determine the number of fetuses and amniotic fluid, but also to identify signs of developmental delay in one of the babies or both, developmental anomalies, type of placentation (mono- or dichorionic ), localization of the placenta / placenta, the presence of a septum (one or two amnions), the position / presentation of the fetus. In addition, ultrasound can detect fusion between twins and help determine the tactics of delivery.

Childbirth, complications, indications for abdominal delivery

Women who are pregnant with more than one fetus rarely live to term.

• twins are more likely to give birth at 36 weeks
• in the presence of triplets, childbirth occurs at 33 - 34 weeks
• with quadruplets, labor begins at 31 - 32 weeks

Therefore, all women expecting more than one child are admitted to the hospital at least 14 days before the expected birth. Children born as a result of multiple pregnancies are often premature and require resuscitation. However, it has been noticed that the maturation of the lungs in twins occurs earlier, which distinguishes them from those born during a singleton pregnancy, so they adapt better and can breathe on their own.

The management of childbirth depends on various factors. The leading role is played by the position and presentation of babies, especially the first one. The presence / absence of water and intrauterine hypoxia of babies, the regularity and intensity of contractions, extragenital and gynecological diseases, and the woman's age are also determined.

Women are allowed into independent childbirth if the first or both fetuses are presented with heads, the condition of the children and the mother is satisfactory, and labor activity is regular.

Indications for operative delivery are primarily determined by the position and presentation of the babies, so, with the presentation of the pelvic end of the first and the presentation of the head of the second, it is advisable to deliver the woman by the abdominal route to prevent a formidable complication - fetal collisions (clutch heads). Also, a caesarean section is performed with the transverse position of the fetus / fetus, with the presentation of the pelvic end of both fetuses, with intrauterine hypoxia of one / both children, anomalies labor activity, and in the case of an existing scar on the uterus. If polyhydramnios is established, severe preeclampsia, large babies and if there are more than two twins, operative delivery is also indicated. Difficulties in childbirth arise in the case of monoamniotic monochorionic twins. In such children, cord entanglement and torsion are often observed, so it is advisable to deliver such a pregnancy by caesarean section.

Postpartum and childbirth complications:

• anomalies of labor activity;
• hypoxia of one / both twins;
• , especially the second fetus (a sharp decrease in intrauterine pressure after the birth of the first child);
• death of children in childbirth and after birth (high rates of perinatal mortality);
• high risk of bleeding during separation of the placenta and in the early postpartum period.

Case Study: A 20-year-old primiparous woman was admitted to the maternity ward with complaints of contractions and effusion amniotic fluid. The woman had never been observed anywhere before, and, accordingly, she had never been on an ultrasound scan. Estimated gestational age is 32 weeks. During an external obstetric examination, I palpated only one (!) Large and a bunch of small parts of the fetus. With difficulty, but identified 2 different places where fetal heartbeats were heard. When conducting an internal study, it was established: the fetal bladder is absent, the opening of the uterine os is 7–8 cm, the legs are presented. The woman on a gurney was transferred to the delivery table, I got up to the table myself (we don’t have time for a caesarean section). And then the nightmare began. Not only was the first birth, premature, twins and the first fetus in a foot presentation, but the woman in labor behaved simply ugly. She tried to get off the table, reached out with her hands to the crotch, trying to push the child back (the midwife and nurse could barely hold the woman), kicked everything and everyone who fell within reach. With great difficulty, but finally we gave birth to our first baby. The child was very ill and was not breathing. After an internal study, I opened the fetal bladder and revealed another surprise - the second child also walks with legs. I never did a fetus turn, and I didn’t even see how it was done, so the nightmare repeated again. They gave birth to a second child, also heavy, but better than the first. After the afterbirth, I said: “Today you almost killed your children,” I left the delivery room (I was replaced by a colleague). But it's good that all ends well. After 5 days in the maternity ward, the woman was transferred to the nursery with her children, from where the large family was discharged in a satisfactory condition.

Obstetrician-gynecologist Anna Sozinova

Hello, dear readers! Today I will try to touch on a complex and rather painful topic for many - IVF. For some it has been a blessing, for others it has been a disappointment. Often with IVF, the chances of getting pregnant with several children are much greater than with conventional fertilization. Is that so, let's try to figure it out!

What does the term "ECO" mean?

The word itself is "in vitro fertilization". With "fertilization" everything is clear, and the words "extra" ("outside") and "corpus" ("body") are taken from Latin. IVF is synonymous with “in vitro fertilization” and is contained in the English analogue of the name – IVF (in vitro fertilization). But in fact, it is a medical procedure that recreates the natural process of conception in the laboratory.

Scientists both abroad and here have been developing this method since the middle of the twentieth century, and many couples have already solved their problem in this way. However, there is no 100% guarantee for everyone that this treatment will be successful. Statistics show that pregnancy occurs in one in three women, and ends with a successful birth in one in four.

The desire to become parents and the excitement about the success of artificial insemination often come into conflict. The cost of the procedure and ethical aspects are also frightening - after all, conception, after all, occurs outside the mother, and in some cases one has to resort to the help of a surrogate mother or use donor sperm.

How is the IVF procedure performed?

The artificial insemination procedure consists of several stages. First you need to get the woman's eggs - in practice, ovarian follicles (oocytes) are taken, and then eggs are extracted from them, already in the laboratory.

In order for the body future mother several eggs have matured, and not one, as in the usual menstrual cycle, the woman previously undergoes a course of hormonal therapy.

Injections or tablets are prescribed for a period of seven to twenty days, and then the oocytes are punctured. This is the only part of the process that can be unpleasant, painful, and therefore is carried out under anesthesia, usually general.

On the day the woman's eggs are taken, the man donates sperm (either naturally or through surgery). Sometimes sperm is taken in advance and stored frozen until the right day. When both components are ready, they are connected.

This is the sacrament of conception under the microscope and the gaze of doctors! There is another term that is often found in conjunction with "IVF" - ICSI (intracytoplasmic sperm injection). Behind the long name is one of two methods of combining eggs and sperm.

The first, more simple, is insemination: many, many spermatozoa are added to a conditional “test tube”, and they themselves fertilize the eggs located there in a special environment. If the quality of sperm confuses specialists, the spermatozoon is injected purposefully, microsurgically. This is ICSI.

An egg fertilized by a sperm cell becomes an embryo. It is stored for several more days in an incubator with a special environment and temperature, and during this time the number of cells in the embryo grows exponentially.

Also at this stage, it is possible to diagnose for pathologies (chromosomal and genetic) of the unborn fetus. The embryo is then transferred into the mother's uterus.

Unlike follicle harvesting, the “planting” process is quick and does not require anesthesia. Everything, further the process of pregnancy and its course does not differ from the usual. After two or three weeks, you can do a pregnancy test or ultrasound, and see if conception was successful in vitro. As with natural conception, there are no guarantees that a miracle happened the first time.

The number of possible new attempts is determined together with the doctor, since it will depend on the woman’s state of health, and the interval between attempts depends on how quickly her hormonal balance is restored (on average, from six months to recover). At the same time, it is possible to save (subject to cryopreservation) the resulting embryos, and use them for future "replanting".

If you talk to mothers who have gone through IVF, you can hear many stories of patience, endurance, determination and sacrifice. Preparing for fertilization with the help of hormones has a strong effect on a woman's body, and this is not easy for everyone.

The cost of treatment is also tangible, and not everyone can afford several attempts. Those who have walked this path look back on the difficulties they endured with a light heart, but one can only try to imagine how hard it is to try everything - and not achieve the desired result!

The probability of twins during IVF

During artificial insemination, several embryos are transferred into the uterus (according to the standards of Russian health care - two). This is done in order to increase the chances of a successful conception. But do they still understand what happens if not one, but several embryos take root? Correctly! Several babies are born!

In medical practice, there are cases of both fraternal and identical (monozygous) twins during conception in vitro. Science cannot influence the appearance of twins in any way - this choice remains in the hands of nature.

The percentage of the probability of having twins (or even more babies) with IVF often scares parents who are not ready for such a “double” happiness. If through IVF you must, but are not ready to become parents of many children (or the health of the future mother does not allow you to bear twins and more), you can be reduced - the removal of one of the embryos.

This is necessary if there are medical contraindications for carrying all babies: a risk to the health of the pregnant woman, children, or one of the children has a pathology that is incompatible with life. In this case, the doctor suggests, and the decision, probably one of the most difficult, is made by the parents.

Reduction - a controversial point in what possibilities science has today, causes the greatest rejection among representatives of church denominations. After all, a person, by definition, has no right to decide who lives and who does not.

I will refrain from emotional comments, I will only note: reduction is not a consequence of IVF, as such, but one of the scenarios that are encountered in multiple pregnancies. No need to be afraid and upset in advance, but you need to understand that you may have to make a choice. And try to be ready for it.

Pregnancy after IVF - if you have twins

By and large, it doesn’t matter if the insemination was artificial or not. The risks are not associated with the method of fertilization, but with the specifics of the pregnancy itself and the health of the expectant mother. Of course, pregnancy with twins has its own, often difficult, features.

Alarming factors are the possibility of a difference in the perinatal development of twins, the death of one of them and complications for the remaining one, a high probability of prematurity, as well as the birth process itself, when children appear one after another. Competent modern doctors know how to carry twins after IVF, how to monitor the condition of a pregnant woman, what drugs to maintain her strength and physical condition.

You may have to significantly limit physical activity, give up yoga or go on maternity leave earlier, lie down for conservation one or more times, and at the final dates you may be recommended a caesarean section to avoid traumatic childbirth.

Do not worry that your condition is checked much more carefully than during a normal pregnancy. For example, both those who conceived in a test tube and future mothers of several babies take a blood test for hCG an order of magnitude more often than their “ordinary” colleagues. This hormone, by definition, is the main assistant to doctors in pregnancy control: it actively grows up to the 11th week, then slows down, and continues to grow, starting from the 22nd.

For mothers who have undergone IVF, hCG level above normal due to preparatory hormone therapy. And mothers of twins - because there are several children. So you need to find out the growth rates of the pregnancy hormone, and then, if you are expecting twins, multiply by two!

Most importantly - do not forget that the happiness associated with the appearance of a child will also be multiplied by two. And if twins are born through IVF, this is generally a state close to euphoria. After all, the desire to become parents, hope, perseverance and faith act in concert with nature, and, as a result, overcome fear, despair and infertility with a double result!

All beautiful and healthy babies! Write, leave feedback, comment and be happy!

With one child, everything was removed by 16 weeks. Now I’m with twins at 16, two mornings at night, it’s already difficult to enter, I started to swallow. I'm in Germany, they don't like extra medicines here, I've never had a discharge. But even my doctor does not recommend canceling, although it is said that the body should already secrete enough of its progesterone.

I drank until 34 weeks, at 20 weeks I canceled 2 pieces of 200 (drank 2 of 200) a week later the neck shortened, maybe a coincidence, we will never know for sure, returned the mornings back. Doctors who said what, who said drink, who said garbage, I drank, I decided that it would not get worse.

I had 800 mornings. from 12 weeks I began to clean every 4 days for 100. By 18 weeks I completely turned off.

They began to remove one at a time from 9 weeks (there were 6 capsules) and once a week they removed it like this. It turns out up to 14 weeks The essence of the battle is not in the fight as such, but in whether the goal is achieved.

With twins after IVF, I started canceling 1 capsule at 17 weeks from the evening dose. In the morning I started bleeding heavily. I had to return this capsule and pierce progesterone in injections for 3 days. she took 1000 instead of the prescribed 600, she was very afraid of losing the pregnancy (there was such an experience at 27 weeks). As a result, she completely canceled at 32 weeks. neck held tight

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Eco pregnancy with twins

After the IVF procedure, twin pregnancy is not uncommon - this is every third case. There is nothing surprising, because several embryos are placed in the female uterus at the same time. There is double joy in the family, but it is not so easy to bear two, you need to be more attentive to your own health.

Pregnancy with IVF

Pregnancy, the onset of which was helped by in vitro fertilization. which is often called IVF, for many women is the joy and last hope of becoming a mother. With IVF, the eggs are fertilized in a test tube, after which the embryos live and grow in it for some time. Then several embryos are transferred to the uterus, where they take root and, as a result, pregnancy occurs.

Do not hide the fact that not all pregnancies end in childbirth. A woman may have a miscarriage, or the pregnancy will freeze - this happens on early dates, during the first trimester, in a third of all pregnancies after IVF.

The reasons leading to these unfortunate consequences are as follows:

• maternal hormonal disorders; woman's age;
• the presence of chronic diseases - cytomegalovirus, herpes simplex virus, mycoplasmosis and others;
• errors in the management of pregnancy by the attending physician;
• genetic disorders in the development of the embryo;
• immune conflict;
• there are chromosomal changes in the germ cells of both spouses;
• antiphospholipid syndrome;
• increased levels of antibodies;
• reduced levels of estrogen;
• undeveloped function of the corpus luteum.

IVF pregnancy with twins can also be interrupted during the second and third trimesters. The reasons for this are as follows:

• emerging intrauterine infections;
• multiple pregnancy;
• placental insufficiency.

If a woman is pregnant with twins, then, in order to eliminate the risks of miscarriage if possible, she should be under the supervision of a doctor from the beginning of pregnancy, correcting all negative changes.

Management of pregnancy

During pregnancy with twins through IVF, it is imperative to conduct regular blood sampling during the first twelve weeks to determine progesterone, estradiol, hCG and, if necessary, hormonal correction.

At a later date, at 16-19 weeks, a Doppler study of blood flow is mandatory. This helps to identify placental insufficiency and preeclampsia.

It is possible that a woman with twins after IVF will need hospitalization and special intensive measures to prevent the onset of preterm labor. If a woman is pregnant with twins, then the risk of early birth of babies is very high. Early childbirth can lead to such unpleasant consequences as the development of neurological diseases.

Twins after IVF

• a woman preparing to give birth is over thirty years old;
• infertility for more than five years;
• diagnosed with placental insufficiency and preeclampsia;
• for a long time the pregnancy was on the verge of termination.

Twins after IVF and congenital pathologies

The good news is that the percentage of congenital pathologies in babies conceived with the help of IVF does not exceed the percentage of changes in children whose conception occurred naturally. There is always a risk of genetic pathologies, but it does not depend on the way in which a new life was born. To reduce the risk of congenital pathologies, preimplantation genetic diagnosis is recommended.

Summary

Conducting IVF methods, pregnancy with twins - so many exciting events. This is happiness, double happiness, you are so lucky. Good luck.

Information

Signs of pregnancy after IVF before hCG

The successful completion of the IVF procedure for all parents is a real event, as their cherished dream, to which they have been going for so long, will finally come true. Passing the in vitro fertilization procedure is not the easiest procedure, so couples must be prepared for it mentally and physically.

First signs of pregnancy after IVF begin to appear after human chorionic gonadotropin enters the woman's blood. To accurately detect pregnancy after the IVF procedure, it is imperative to conduct an analysis to determine the amount of gonadotropin contained in the blood.

HCG after IVF can rise up to the 20th week of pregnancy.

In addition, for a large amount of content chorionic gonadotropin doctors may assume that it has come multiple pregnancy. But a successful IVF procedure most often leads to the development of twins, so couples are preparing for this. Unfortunately, the first trimester of pregnancy is associated with a high risk of abortion, so doctors often prescribe an ultrasound scan to determine the threat to the growing embryo.

You should not lose your head from a successful IVF procedure, because at such moments a woman does not pay due attention to her health.

Embryo implantation in the uterus - how does pregnancy occur

The embryo is born after the egg has been able to "dock" to the walls of the uterus. At this moment, its active growth begins and further development. Embryo implantation after IVF occurs after 7 days from the date of the procedure itself. Artificially planted oocytes should independently attach themselves to the walls of the uterus.